235:
after trying several treatment strategies, but his or her odds of beating the depression diminish as additional treatment strategies are needed." With failed treatment at a higher step, the chances of remission were smaller ā and this decrease was particularly significant after level two. For those who did achieve full remission, there was a decreased chance of relapse at 12-month (naturalistic) follow-up compared to those patients who only responded.
215:, had similar response and remission rates compared to those who were receiving medication(s) only; however, for those patients who remained on citalopram, those who had another antidepressant added achieved remission more rapidly than those who had CBT added. Among the patients who were switched to a different antidepressant, there was no
234:
Overall, the study findings indicate that patients who do not achieve remission or response after several weeks of citalopram treatment could achieve those outcomes by the end of 14 weeks. The STAR*D researchers state that their data "suggest that a patient with persistent depression can get well
149:
or CBT added to citalopram), and four switch options (to either a different antidepressant or CBT). Those who remitted or responded were offered 12-month naturalistic follow-up; non-remitters after two medication trials were encouraged to enter level 3; other non-remitters entered level 2A, which
95:
the treatments (i.e. the patient and clinician both knew what treatment the patient was receiving). The STAR*D trial included remission (the near-absence of symptoms, rather than simply a reduction in symptoms) as an outcome measure, as there is evidence that patients with depression who achieve
257:
STAR*D changed the inclusion and exclusion criteria for subjects during the study, so 931 subjects were included when they met the exclusion criteria, and 370 subjects were excluded while they met the inclusion criteria. These changes resulted in an increase in the average score of the subjects:
226:
symptom scale were 12.3% for mirtazapine and 19.8% for nortriptyline, although the difference was not large enough for statistical significance. The remission rates based on the HAM-D in the combination strategy were 15.9% for lithium and 24.7% for triiodothyronine, but the difference was not
721:
Although the study's reports make no mention of this outcome, their data show that after a year of continuation treatment following remission, of the 4,041 patients who entered the program only 108 (3%) had a sustained remission ā all the other patients either dropped out or
692:
Psychology Today "Thus, if the study protocol had been followed and the results honestly reported, the researchers would have announced that 38% of the patients remitted during the four steps of treatment, and that the remaining 62% either dropped out or failed to
606:"What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR*D study's patient-level data with fidelity to the original research protocol"
375:"What are the treatment remission, response and extent of improvement rates after up to four trials of antidepressant therapies in real-world depressed patients? A reanalysis of the STAR*D study's patient-level data with fidelity to the original research protocol"
230:
For level four, the average remission rate was 13%, with no statistically significant difference between tranylcypromine and the venlafaxine/mirtazapine combination. More patients receiving tranylcypromine left the study due to side effects.
118:
The trial involved four different treatment levels, and patients were encouraged to enter the next level of treatment if they failed to achieve remission or response (50% reduction in symptoms) after a specified number of weeks.
195:
For level one, the remission rate was 28-33% (depending on the symptom scale used), and the response rate was 47%. Higher remission rates were seen in patients who were
Caucasian, female, employed, or had higher levels of
261:
Only 7% of subjects in remission remained stable and stayed in the study until the end. This represents only 3% of subjects according to the original inclusion and exclusion criteria (108 out of 3,671). This has not been
258:
according to the inclusion and exclusion criteria provided by the original protocol, the remission rate was 38%; according to the inclusion and exclusion criteria implemented retrospectively, the remission rate is 67%.
130:(SSRI) citalopram for up to 14 weeks, with adjustment of the dose being managed by their own physicians. If patients achieved remission or response during that time period, they could enter a 12-month
115:
The STAR*D trial enrolled 4,041 outpatients with nonpsychotic depression at 23 psychiatric and 18 primary care sites. The trial was completed in 2006, and data from it has been available since 2008.
423:
483:
767:
134:
follow-up, during which time the researchers did not have any influence over the treatment plan. Non-remitters were encouraged to enter level two.
127:
107:
This report had profound impact on the promotion of antidepressants but later accused of having been subjected to multiple levels of fraud.
250:
The research contract provided for the assessment of depression by the HRSD and IDS-C30 scales. Instead, depression was assessed using an
689:
76:
59:
762:
461:
287:
227:
statistically significant. However, more patients receiving lithium than triiodothyronine left the study due to side effects.
737:
703:
Leventhal, Allan M.; Antonuccio, David O. (2009). "On
Chemical Imbalances, Antidepressants, and the Diagnosis of Depression".
330:
Sinyor M, Schaffer A, Levitt A (2010). "The
Sequenced Treatment Alternatives to Relieve Depression (STAR*D) Trial: A Review".
238:
A reanalysis published in 2023 concluded that STAR*Dās cumulative remission rate was approximately half of that reported.
138:
173:
574:
216:
205:
131:
539:
Howland RH (2008). "Sequenced
Treatment Alternatives to Relieve Depression (STAR*D)--Part 2: Study Outcomes".
477:
154:
97:
92:
355:
254:
study scale (QIDS-SR), which was used for both medical decision-making and scientific evaluation.
88:
635:
556:
453:
404:
347:
201:
84:
747:
712:
671:
625:
617:
548:
443:
435:
394:
386:
339:
158:
79:. Its main focus was on the treatment of depression in patients where the first prescribed
176:
498:
630:
605:
399:
448:
146:
80:
756:
748:
Clinical Trial Info - Sequenced
Treatment Alternatives to Relieve Depression (STAR*D)
166:
142:
72:
31:
359:
161:(a thyroid hormone) to their antidepressant, or a switch to another antidepressant (
579:
Project website for NIMH-funded collaborative study on the treatment of depression
552:
373:
Pigott, H Edmund; Kim, Thomas; Xu, Colin; Kirsch, Irving; Amsterdam, Jay (2023).
246:
Criticism of bias has been raised by certain researchers about the STAR*D trial:
743:
Efficacy of Botox versus
Placebo for Treatment of Patients with Major Depression
621:
390:
282:
277:
184:
180:
162:
716:
343:
374:
272:
212:
208:, co-occurring anxiety or substance use disorders, and more physical illness.
675:
439:
659:
639:
560:
457:
408:
351:
211:
For level two, patients who received CBT, either alone or combined with
123:
101:
582:
87:
to real clinical situations; this was done through the use of minimal
83:
proved inadequate. A key feature of the study was its aim to be more
197:
604:
Pigott, H. E.; Kim, T.; Xu, C.; Kirsch, I.; Amsterdam, J. (2023).
223:
137:
In level two, there were seven different treatment options, and
742:
104:
than those who achieve only partial improvement in symptoms
738:
541:
145:
option. There were three combination options (either an
204:. Lower remission rates were seen in those with longer
67:
Sequenced
Treatment Alternatives to Relieve Depression (
153:
In level three, patients were offered the addition of
55:
45:
37:
26:
21:
222:For level three, the remission rates based on the
219:difference among the different antidepressants.
71:) was a collaborative study on the treatment of
434:(1). National Institute of Mental Health: 5ā7.
690:The STAR*D Scandal: A New Paper Sums It All Up
8:
482:: CS1 maint: multiple names: authors list (
91:, incorporating patient preference, and not
581:. University of Pittsburgh. Archived from
629:
534:
532:
530:
528:
526:
524:
522:
520:
518:
447:
398:
325:
323:
653:
651:
649:
321:
319:
317:
315:
313:
311:
309:
307:
305:
303:
150:involved a second antidepressant trial.
30:Collaborative study on the treatment of
705:Ethical Human Psychology and Psychiatry
664:Ethical Human Psychology and Psychiatry
299:
475:
128:selective serotonin reuptake inhibitor
100:function better and are less prone to
18:
768:Clinical trials related to depression
499:"Does Adderall Help With Depression?"
428:Blog Publication by the NIMH Director
7:
424:"Beyond Efficacy: The STAR*D Trial"
77:National Institute of Mental Health
60:National Institute of Mental Health
660:"STAR*D: A Tale and Trail of Bias"
332:The Canadian Journal of Psychiatry
14:
497:BS, Amanda Stevens (2023-02-10).
169:). This continued for 12 weeks.
16:Study on treatment of depression
422:Insel, Thomas R., M.D. (2006).
288:Pharmacology of antidepressants
1:
553:10.3928/02793695-20081001-05
172:Level four consisted of the
139:cognitive behavioral therapy
622:10.1136/bmjopen-2022-063095
391:10.1136/bmjopen-2022-063095
174:monoamine oxidase inhibitor
784:
717:10.1891/1559-4343.11.3.199
658:Pigott, H. Edmund (2011).
344:10.1177/070674371005500303
141:(CBT) was included as the
676:10.1891/1559-4343.13.1.6
440:10.1176/appi.ajp.163.1.5
763:Treatment of depression
688:Robert Whitaker (2010)
575:"STAR*D: Latest News"
51:18 primary care sites
179:or a combination of
503:New Waters Recovery
206:depressive episodes
49:23 psychiatric and
89:exclusion criteria
65:
64:
775:
725:
724:
700:
694:
686:
680:
679:
655:
644:
643:
633:
601:
595:
594:
592:
590:
571:
565:
564:
536:
513:
512:
510:
509:
494:
488:
487:
481:
473:
471:
469:
460:. Archived from
451:
419:
413:
412:
402:
370:
364:
363:
327:
159:triiodothyronine
75:, funded by the
19:
783:
782:
778:
777:
776:
774:
773:
772:
753:
752:
734:
729:
728:
702:
701:
697:
687:
683:
657:
656:
647:
603:
602:
598:
588:
586:
585:on 5 March 2013
573:
572:
568:
538:
537:
516:
507:
505:
496:
495:
491:
474:
467:
465:
421:
420:
416:
372:
371:
367:
329:
328:
301:
296:
269:
244:
193:
177:tranylcypromine
113:
50:
17:
12:
11:
5:
781:
779:
771:
770:
765:
755:
754:
751:
750:
745:
740:
733:
732:External links
730:
727:
726:
695:
681:
645:
616:(7): e063095.
596:
566:
514:
489:
414:
385:(7): e063095.
365:
338:(3): 126ā135.
298:
297:
295:
292:
291:
290:
285:
280:
275:
268:
265:
264:
263:
259:
255:
243:
240:
192:
189:
147:antidepressant
122:In level one,
112:
109:
81:antidepressant
63:
62:
57:
53:
52:
47:
43:
42:
39:
35:
34:
28:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
780:
769:
766:
764:
761:
760:
758:
749:
746:
744:
741:
739:
736:
735:
731:
723:
718:
714:
710:
706:
699:
696:
691:
685:
682:
677:
673:
669:
665:
661:
654:
652:
650:
646:
641:
637:
632:
627:
623:
619:
615:
611:
607:
600:
597:
584:
580:
576:
570:
567:
562:
558:
554:
550:
547:(10): 21ā24.
546:
542:
535:
533:
531:
529:
527:
525:
523:
521:
519:
515:
504:
500:
493:
490:
485:
479:
464:on 2014-04-04
463:
459:
455:
450:
445:
441:
437:
433:
429:
425:
418:
415:
410:
406:
401:
396:
392:
388:
384:
380:
376:
369:
366:
361:
357:
353:
349:
345:
341:
337:
333:
326:
324:
322:
320:
318:
316:
314:
312:
310:
308:
306:
304:
300:
293:
289:
286:
284:
281:
279:
276:
274:
271:
270:
266:
260:
256:
253:
249:
248:
247:
241:
239:
236:
232:
228:
225:
220:
218:
214:
209:
207:
203:
199:
190:
188:
186:
182:
178:
175:
170:
168:
167:nortriptyline
164:
160:
156:
151:
148:
144:
143:psychotherapy
140:
135:
133:
129:
126:received the
125:
120:
116:
110:
108:
105:
103:
99:
94:
90:
86:
85:generalizable
82:
78:
74:
70:
61:
58:
54:
48:
44:
40:
36:
33:
29:
25:
20:
720:
708:
704:
698:
684:
667:
663:
613:
609:
599:
587:. Retrieved
583:the original
578:
569:
544:
540:
506:. Retrieved
502:
492:
478:cite journal
466:. Retrieved
462:the original
431:
427:
417:
382:
378:
368:
335:
331:
251:
245:
237:
233:
229:
221:
210:
194:
171:
152:
136:
132:naturalistic
121:
117:
114:
106:
68:
66:
589:10 February
283:Mirtazapine
278:Venlafaxine
217:significant
185:mirtazapine
181:venlafaxine
163:mirtazapine
757:Categories
711:(3): 205.
508:2023-04-15
294:References
273:Citalopram
262:specified.
213:citalopram
73:depression
32:depression
27:Study type
252:ex-nihilo
242:Criticism
202:education
98:remission
46:Locations
722:relapsed
670:: 6ā28.
640:37491091
631:10373710
610:BMJ Open
561:18935932
458:16390879
409:37491091
400:10373710
379:BMJ Open
360:19442084
352:20370962
267:See also
124:patients
93:blinding
693:remit."
468:4 April
449:1586101
191:Results
155:lithium
102:relapse
56:Funding
638:
628:
559:
456:
446:
407:
397:
358:
350:
198:income
69:STAR*D
22:STAR*D
356:S2CID
224:HAM-D
111:Trial
38:Dates
636:PMID
591:2013
557:PMID
484:link
470:2014
454:PMID
405:PMID
348:PMID
183:and
41:2006
713:doi
672:doi
626:PMC
618:doi
549:doi
444:PMC
436:doi
432:163
395:PMC
387:doi
340:doi
200:or
165:or
157:or
759::
719:.
709:11
707:.
668:13
666:.
662:.
648:^
634:.
624:.
614:13
612:.
608:.
577:.
555:.
545:46
543:.
517:^
501:.
480:}}
476:{{
452:.
442:.
430:.
426:.
403:.
393:.
383:13
381:.
377:.
354:.
346:.
336:55
334:.
302:^
187:.
715::
678:.
674::
642:.
620::
593:.
563:.
551::
511:.
486:)
472:.
438::
411:.
389::
362:.
342::
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.